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813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received I I Phone Contact for Permit 1 21. 19S-I R 1 I q q3 <br /> Owner's Name 14 eA1 1 rart,d - He ,Z / 1GN4e L i Owner's Phone Number <br /> . * <br /> Owner's Address 3 a 116417 Pr. Z� hf6 /, / 33 5ef <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 3 t'dAo /A Pr. 20y1)7(//,s I/• 7 K✓74 Lot # <br /> Sub Division Parcel # <br /> I I Bio- Hazard Waste Storage - ANNUAL pi Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Comm Exhaust Kitchen Hood /Duct I Hood Installation <br /> I — I Controlled Burn I LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> 7 Emergency Generator > 30 kw I I Places of Assembly-ANNUAL �� _`\ <br /> I x I Fire Protection Maintenance - ANNUAL Recreational Burn <br /> tQtrly1 eml Fn LOther „ A� <br /> Sprinkler 1 ❑ ❑ I Sparklers Vv { <br /> Fire Alarm I Imo` — I El ❑ I n I� Sprinkler System Installations . Q ” I ,r <br /> Hood Cleaning <br /> 9 ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) 14' <br /> -4 e Hood Suppression C ❑ ❑ ❑ 1 1 Torch Roofing/Tar Kettle ^^� <br /> Fire Alarm Installation I I Waste Tire Storage ANNUAL i` <br /> I I Fire Pumps ti i 1 <br /> I I Fire Works <br /> 7 Flammable Application- ANNUAL <br /> 1 Val Uatlbn 4€ PfOjeCt <br /> n Fuel Tanks <br /> 7 Other: I <br /> Contactor Company A "TiDta 1 5o lu 4-■ o <br /> Signature •r i Registered Y / N I Fee Current 1 Y / N I <br /> Address 1 35 3 1 I'eL &konE, 1 License # I qg 35 31000 I AQo 2, I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address I I License # <br /> PLUMBER l Company <br /> Signature I Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # i <br /> MECHANICAL Company <br /> Signature Registered Y/ N . 1 Fee Current I Y / N 1 <br /> Address I License # <br /> OTHER I Company <br /> Signature I Registered Y/ N I Fee Current I Y / N I <br /> Address 1 I License # I <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br /> D <br />